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Book Details
Abstract
Endocrine Surgery meets the needs of surgeons in higher training and practising consultants for a contemporary and evidence-based account of this sub-specialty that is relevant to their general surgical practice. It is a practical reference source incorporating the most current information on recent developments, management issues and operative procedures. The text is thoroughly referenced and supported by evidence-based recommendations wherever possible, distinguishing between strong evidence to support a conclusion, and evidence suggesting that a recommendation can be reached on the balance of probabilities.
This is a title in the Companion to Specialist Surgical Practice series whose eight volumes are an established and highly regarded source of information for the specialist general surgeon.
- The Companion to Specialist Surgical Practice series provides a current and concise summary of the key topics within each major surgical sub-specialty.
- Each volume highlights evidence-based practice both in the text and within the extensive list of references at the end of every chapter.
- An expanded authorship team across the series includes additional European and World experts with an increased emphasis on global practice.
- The contents of the series have been extensively revised in line with recently published evidence.
- All the chapters reflect the multidisciplinary approach to the subject with up-to-date information on cytopathology, assays of hormones, localisation techniques, anaesthetic requirements, genetic implications and, of course, histopathology and adjuvant treatments.
- Minimally invasive approaches continue to be promoted and developed throughout the book.
- The text has a closer emphasis on practical and pragmatic approaches to clinical scenarios.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Endocrine Surgery: A COMPANION TO SPECIALIST SURGICAL PRACTICE | iii | ||
| Copyright | iv | ||
| Contents | v | ||
| Contributors | vii | ||
| Series Editors' preface | ix | ||
| Editor's preface | xi | ||
| Evidence-based practice in surgery | xiii | ||
| Chapter 1: Parathyroid disease | 1 | ||
| Part 1. Parathyroid disease, syndromes and pathophysiology | 1 | ||
| Introduction | 1 | ||
| Embryology and anatomy | 1 | ||
| Calcium and parathyroid hormone (PTH) regulation | 2 | ||
| Primary hyperparathyroidism | 3 | ||
| Incidence | 3 | ||
| Clinical manifestations | 3 | ||
| Diagnosis | 3 | ||
| Normocalcaemic hyperparathyroidism | 4 | ||
| Hypercalcaemic crisis | 5 | ||
| Surgical indications | 8 | ||
| Imaging and localisation | 9 | ||
| Ultrasound (US) | 9 | ||
| Computed tomography (CT) | 11 | ||
| Magnetic resonance imaging (MRI) | 11 | ||
| Thallium-201–technetium-99 m pertechnetate scan (Tl–99mTc scan) | 11 | ||
| Technetium-99 m sestamibi scan (sestamibi scan) | 12 | ||
| Parathyroid angiography and venous sampling for PTH | 14 | ||
| Pathology | 14 | ||
| Adenoma | 15 | ||
| Double adenoma | 15 | ||
| Hyperplasia | 15 | ||
| Carcinoma | 15 | ||
| Secondary hyperparathyroidism (SHP) | 16 | ||
| Pathogenesis | 16 | ||
| Hypocalcaemia and hyperphosphataemia | 16 | ||
| Decreased synthesis of calcitriol | 16 | ||
| Bony resistance to PTH | 16 | ||
| Changes in PTH set point | 16 | ||
| Aluminium intoxication | 16 | ||
| Presentation | 17 | ||
| Osseous lesions | 17 | ||
| Pruritus | 17 | ||
| Metastatic calcification | 17 | ||
| Calciphylaxis | 17 | ||
| Treatment | 17 | ||
| Tertiary hyperparathyroidism | 17 | ||
| References | 18 | ||
| Part 2. Operative strategy for themanagement of parathyroid disease | 21 | ||
| Primary hyperparathyroidism | 21 | ||
| Conventional open parathyroidectomy | 21 | ||
| Basic principles of parathyroid surgery | 21 | ||
| Management of surgical procedure | 22 | ||
| The search for superior parathyroid (P IV) | 22 | ||
| The search for inferior parathyroid (P III) | 23 | ||
| Evaluation of the initial bilateral exploration | 23 | ||
| Continuation of the exploration | 24 | ||
| The parathyroidectomy | 25 | ||
| Solitary parathyroid adenoma (Fig. 1.12) | 25 | ||
| Sporadic multiglandular disease | 25 | ||
| Familial hyperparathyroidism | 26 | ||
| Primary hyperparathyroidism in MEN1 | 26 | ||
| Primary hyperparathyroidism in MEN2A | 26 | ||
| Parathyroid carcinoma | 27 | ||
| Parathyroidectomy associated with thyroid excisions | 27 | ||
| Overall results of conventional open parathyroidectomy | 27 | ||
| Minimally invasive parathyroidectomy (MIP) | 28 | ||
| Unilateral neck exploration | 28 | ||
| Open minimally invasive parathyroidectomy (OMIP) | 28 | ||
| Minimally invasive radio-guided parathyroidectomy (MIRP) | 29 | ||
| Endoscopic parathyroidectomy | 29 | ||
| MIP in the broader context | 30 | ||
| Intraoperative parathyroid hormone assay (ioPTH) | 31 | ||
| Re-operation for persistent or recurrent primary hyperparathyroidism (PHP) | 31 | ||
| Analysis of causes of failure | 31 | ||
| Management | 31 | ||
| Confirmation of the diagnosis | 31 | ||
| Case history | 31 | ||
| Preoperative evaluation | 32 | ||
| Methods of re-operation | 32 | ||
| The posterolateral approach (‘back-door’ approach) | 33 | ||
| The thyrothymic approach (‘front-door’ approach) | 33 | ||
| Revision of the transverse cervicotomy | 33 | ||
| Mediastinal approaches | 33 | ||
| Other focused approaches | 33 | ||
| Additional procedures | 33 | ||
| Results | 33 | ||
| Secondary hyperparathyroidism (SHP) | 34 | ||
| Hyperparathyroidism secondary to compensatory stimulation of parathyroid hormone | 34 | ||
| Surgical strategies | 34 | ||
| Perioperative care | 35 | ||
| Persistent and recurrent SHP | 35 | ||
| Lithium-induced hyperparathyroidism | 36 | ||
| Tertiary hyperparathyroidism | 36 | ||
| References | 37 | ||
| Chapter 2: The thyroid gland | 41 | ||
| Background | 41 | ||
| Embryology, surgical anatomy and physiology | 41 | ||
| Embryology | 41 | ||
| Thyroid anatomy | 41 | ||
| Recurrent laryngeal nerve and external branch of superior laryngeal nerve anatomy | 41 | ||
| Parathyroid anatomy | 42 | ||
| Thyroid physiology | 42 | ||
| Clinical history and examination | 43 | ||
| Investigation of the thyroid | 43 | ||
| Blood tests | 44 | ||
| Thyroid function tests | 44 | ||
| Thyroid antibodies | 44 | ||
| Thyroglobulin antibody | 44 | ||
| Thyroid peroxidase antibody | 45 | ||
| TSH receptor antibody | 45 | ||
| Biomarkers of malignant disease | 45 | ||
| Thyroglobulin | 45 | ||
| Calcitonin | 45 | ||
| Carcinoembryonic antigen | 45 | ||
| Imaging studies | 45 | ||
| Ultrasonography | 45 | ||
| Nuclear medicine studies | 45 | ||
| Computed tomography | 45 | ||
| Tissue diagnosis | 46 | ||
| Incidental thyroid pathology | 46 | ||
| Surgical pathologies of the thyroid | 47 | ||
| Benign conditions | 47 | ||
| Benign goitre | 47 | ||
| Causes of multinodular goitre | 48 | ||
| Iodine deficiency | 48 | ||
| Genetics | 48 | ||
| Goitrogens | 48 | ||
| Gender | 48 | ||
| Drugs | 48 | ||
| Pathogenesis | 48 | ||
| Management of benign MNG | 48 | ||
| Thyroid cysts | 48 | ||
| Malignant conditions | 49 | ||
| Molecular biology of thyroid cancers | 49 | ||
| Papillary thyroid carcinoma | 49 | ||
| Follicular thyroid carcinoma | 49 | ||
| Differentiated thyroid cancers (PTC and FTC) | 49 | ||
| Risk factors | 49 | ||
| Pathology | 50 | ||
| Papillary thyroid carcinoma | 50 | ||
| Follicular thyroid carcinoma | 50 | ||
| Staging | 51 | ||
| Work-up | 51 | ||
| Management of DTC | 52 | ||
| Surgery of DTC | 52 | ||
| Extent of thyroidectomy | 52 | ||
| Contraindications to total thyroidectomy | 53 | ||
| Lymph node dissection | 53 | ||
| Adjuvant treatments | 54 | ||
| Follow-up | 54 | ||
| Poorly differentiated thyroid cancer (PDTC) | 54 | ||
| Medullary thyroid carcinoma | 54 | ||
| Pathology | 54 | ||
| Clinical features | 55 | ||
| Diagnosis | 55 | ||
| Treatment | 55 | ||
| Prognosis | 56 | ||
| Follow-up | 56 | ||
| Anaplastic thyroid carcinoma | 56 | ||
| Other malignancies | 56 | ||
| Primary thyroid lymphoma | 56 | ||
| Squamous cell carcinoma | 57 | ||
| Metastatic carcinoma to the thyroid | 57 | ||
| Hyperthyroidism | 57 | ||
| Causes | 57 | ||
| Clinical features | 57 | ||
| Investigations | 57 | ||
| Diagnosis of thyrotoxicosis | 57 | ||
| Determination of aetiology | 58 | ||
| End-organ effects | 59 | ||
| Management | 59 | ||
| Symptomatic management | 59 | ||
| Management – Graves' disease | 59 | ||
| 131 I | 59 | ||
| ATD | 59 | ||
| Management – TMNG | 59 | ||
| Management – TA | 59 | ||
| Surgical indications | 59 | ||
| Operative strategy | 59 | ||
| Preoperative considerations | 59 | ||
| Operative considerations | 60 | ||
| Postoperative considerations | 61 | ||
| Thyroiditis | 61 | ||
| Subacute thyroiditis (de Quervain's thyroiditis) | 61 | ||
| Autoimmune thyroiditis (Hashimoto's thyroiditis) | 61 | ||
| Riedel's thyroiditis | 61 | ||
| Acute suppurative thyroiditis | 61 | ||
| Postpartum thyroiditis | 61 | ||
| Surgery of the thyroid | 62 | ||
| Unilateral total thyroid lobectomy (hemithyroidectomy) | 62 | ||
| Preparation | 62 | ||
| Exposure | 62 | ||
| Mobilisation | 62 | ||
| RLN and parathyroid glands | 63 | ||
| Total thyroidectomy | 64 | ||
| Retrosternal goitre | 64 | ||
| Recurrent goitre | 64 | ||
| Neuromonitoring | 64 | ||
| Sutureless thyroidectomy | 64 | ||
| Minimally invasive and robotic surgery | 64 | ||
| Complications of thyroidectomy | 65 | ||
| Recurrent laryngeal nerve injury | 65 | ||
| External branch of superior laryngeal nerve injury | 65 | ||
| Hypoparathyroidism | 65 | ||
| Recurrent hyperthyroidism | 65 | ||
| Thyroid crisis/storm | 65 | ||
| Haemorrhage/airway obstruction | 65 | ||
| Miscellaneous | 66 | ||
| References | 66 | ||
| Chapter 3: The adrenal glands | 70 | ||
| Anatomy | 70 | ||
| Blood supply and lymphatic drainage | 70 | ||
| Nerve supply | 70 | ||
| Microscopic anatomy | 70 | ||
| Embryology | 71 | ||
| Physiology | 71 | ||
| Adrenal medulla | 71 | ||
| Catecholamine synthesis and metabolism | 71 | ||
| Catecholamine physiological effects | 72 | ||
| Adrenal cortex | 72 | ||
| Mineralocorticoids | 72 | ||
| Glucocorticoids | 73 | ||
| Sex steroids | 73 | ||
| Adrenal incidentaloma | 73 | ||
| Case study 1 | 73 | ||
| Definition and incidence | 73 | ||
| Aetiology | 73 | ||
| Investigation | 74 | ||
| Biochemistry | 74 | ||
| Biopsy | 74 | ||
| Imaging | 74 | ||
| Management | 75 | ||
| Case study 1 (discussion) | 75 | ||
| Adrenocortical carcinoma | 76 | ||
| Case study 2 | 76 | ||
| Incidence and aetiology | 76 | ||
| Clinical features | 76 | ||
| Biochemistry | 76 | ||
| Imaging | 76 | ||
| Diagnosis and staging | 77 | ||
| Treatment | 77 | ||
| Surgery | 77 | ||
| Medical | 77 | ||
| Prognosis | 77 | ||
| Case study 2 (discussion) | 78 | ||
| Phaeochromocytoma and paraganglioma | 78 | ||
| Case study 3 | 78 | ||
| Incidence and aetiology | 78 | ||
| Clinical presentation | 80 | ||
| Biochemical diagnosis | 80 | ||
| Imaging | 80 | ||
| Medical management | 81 | ||
| Surgical management | 82 | ||
| Case study 4 | 82 | ||
| Malignant phaeochromocytoma | 82 | ||
| Phaeochromocytoma in pregnancy | 82 | ||
| Case study 3 (discussion) | 83 | ||
| Case study 4 (discussion) | 84 | ||
| Cushing's syndrome | 84 | ||
| Case study 5 | 84 | ||
| Definition and aetiology | 84 | ||
| Clinical features | 84 | ||
| Biochemical diagnosis | 84 | ||
| ACTH-dependent Cushing's syndrome | 86 | ||
| Imaging | 86 | ||
| Chapter 4: Familial endocrine disease: genetics, clinical presentation and management | 98 | ||
| Introduction | 98 | ||
| A brief overview of clinical endocrine genetics | 98 | ||
| Multiple endocrine neoplasia type 1 (MEN1) | 100 | ||
| Genetics | 100 | ||
| Presentation | 101 | ||
| Primary hyperparathyroidism | 101 | ||
| Enteropancreatic islet tumours | 101 | ||
| Pituitary tumours | 101 | ||
| Foregut carcinoids | 101 | ||
| Adrenocortical tumours | 102 | ||
| Cutaneous manifestations | 102 | ||
| Diagnosis | 102 | ||
| Management | 102 | ||
| Primary hyperparathyroidism | 102 | ||
| Enteropancreatic islet tumours | 102 | ||
| Pituitary tumours | 104 | ||
| Foregut carcinoids | 104 | ||
| Surveillance and screening | 104 | ||
| Genetic testing | 104 | ||
| Biochemical and radiological surveillance | 104 | ||
| MEN1: differential diagnosis | 105 | ||
| Familial isolated pituitary adenoma (FIPA) | 105 | ||
| Presentation | 105 | ||
| Management | 105 | ||
| Familial intestinal carcinoid | 105 | ||
| Multiple endocrine neoplasia type 2 | 106 | ||
| Genetics | 106 | ||
| Presentation | 107 | ||
| Chapter 5: Endocrine tumours of the pancreas | 125 | ||
| Introduction | 125 | ||
| Insulinoma | 125 | ||
| Presentation | 125 | ||
| Diagnosis | 127 | ||
| Supervised standard fasting test | 127 | ||
| Nesidioblastosis | 128 | ||
| Management | 129 | ||
| Medical management of hypoglycaemia | 129 | ||
| Preoperative tumour localisation | 129 | ||
| Non-invasive imaging studies | 129 | ||
| Invasive localising procedures | 129 | ||
| Operative management | 131 | ||
| Open exploration | 131 | ||
| Resection of insulinoma | 132 | ||
| Insulinoma and MEN1 | 132 | ||
| Laparoscopic surgery | 133 | ||
| Outcome | 133 | ||
| Gastrinoma | 133 | ||
| Patient presentation | 134 | ||
| Diagnosis | 134 | ||
| Management | 134 | ||
| Medical control of gastric acid hypersecretion | 134 | ||
| Preoperative tumour localisation | 136 | ||
| Non-invasive tumour-localising studies | 136 | ||
| Invasive tumour-localising modalities | 137 | ||
| Surgery for tumour eradication | 137 | ||
| Operative approach | 137 | ||
| Intraoperative manoeuvres to find the primary gastrinoma | 137 | ||
| Tumour resection | 138 | ||
| Gastrinoma and MEN1 | 139 | ||
| Outcome | 140 | ||
| Non-functional pNETs | 140 | ||
| Other rare endocrine tumours of the pancreas | 140 | ||
| Malignant pNETs | 141 | ||
| Evaluation of metastatic disease | 141 | ||
| Surgical management | 141 | ||
| Non-surgical management | 142 | ||
| References | 143 | ||
| Chapter 6: Gastrointestinal neuroendocrine tumours | 147 | ||
| Introduction | 147 | ||
| Oesophageal NETs | 148 | ||
| Gastric NETs | 149 | ||
| Type 1: gastric NETs associated with chronic atrophic gastritis | 149 | ||
| Type 2: NETs associated with ZES in MEN1 patients | 150 | ||
| Type 3: sporadic gastric NETs | 151 | ||
| Gastrinoma | 152 | ||
| Poorly differentiated gastric neuroendocrine carcinomas | 152 | ||
| Clinical evaluation | 152 | ||
| Symptoms and patient history | 152 | ||
| Diagnosis | 152 | ||
| Treatment | 153 | ||
| CAG-associated type 1 gastric NETs | 153 | ||
| MEN1-related type 2 gastric NETs | 153 | ||
| Sporadic type 3 gastric NETs | 154 | ||
| Poorly differentiated NECs | 154 | ||
| Duodenal NETs | 154 | ||
| Gastrinomas | 154 | ||
| Somatostatin-rich NETs | 154 | ||
| Gangliocytic paragangliomas | 155 | ||
| Other duodenal NETs | 155 | ||
| Duodenal NECs | 155 | ||
| Pancreatic NETs | 155 | ||
| Jejuno-ileal (small-intestinal) NETs (midgut carcinoids) | 156 | ||
| Morphological features | 156 | ||
| Clinical symptoms | 157 | ||
| Carcinoid syndrome | 158 | ||
| Diagnosis | 158 | ||
| Biochemistry | 158 | ||
| Pentagastrin provocation test | 159 | ||
| Radiology | 159 | ||
| Computed tomography | 159 | ||
| Ultrasound | 159 | ||
| OctreoScan® | 159 | ||
| Positron emission tomography (PET) | 159 | ||
| Histology | 159 | ||
| Surgery | 160 | ||
| Surgical technique | 161 | ||
| Liver metastases | 164 | ||
| Liver surgery | 164 | ||
| Radiofrequency or microwave ablation | 165 | ||
| Liver embolisation | 165 | ||
| Liver transplantation | 166 | ||
| Prophylaxis against carcinoid crisis | 166 | ||
| Medical treatment | 167 | ||
| Radiotherapy | 167 | ||
| Survival | 167 | ||
| Appendiceal NETs | 168 | ||
| Atypical goblet-cell NETs | 169 | ||
| Colon NETs | 169 | ||
| Rectal NETs | 169 | ||
| Presentation | 169 | ||
| Diagnosis and immunohistochemistry | 170 | ||
| Treatment | 171 | ||
| Outcome | 171 | ||
| Recommendations | 171 | ||
| References | 173 | ||
| Chapter 7: Clinical governance, ethics and medicolegal aspects of endocrine surgery | 178 | ||
| Clinical governance | 178 | ||
| What is good practice? | 179 | ||
| Who should perform surgery on the endocrine glands? | 179 | ||
| The advantages of subspecialisation | 180 | ||
| Thyroid surgery | 181 | ||
| Chapter 8: The salivary glands | 191 | ||
| Introduction | 191 | ||
| Surgical anatomy | 191 | ||
| The parotid gland | 191 | ||
| Facial nerve | 191 | ||
| The submandibular gland | 192 | ||
| The sublingual gland | 192 | ||
| Investigations | 192 | ||
| Clinical assessment | 192 | ||
| Imaging | 192 | ||
| Fine-needle aspiration cytology | 193 | ||
| Sialendoscopy | 194 | ||
| Non-neoplastic disease of the salivary glands | 194 | ||
| Inflammatory conditions | 194 | ||
| Acute viral inflammation | 194 | ||
| Acute suppurative sialadenitis | 195 | ||
| Chronic inflammatory conditions | 195 | ||
| Mycobacterium tuberculosis | 195 | ||
| Atypical tuberculosis | 195 | ||
| Cat-scratch disease | 195 | ||
| Actinomycosis | 196 | ||
| Sarcoidosis | 196 | ||
| Sjögren's syndrome | 196 | ||
| Human immunodeficiency virus | 197 | ||
| Sialolithiasis | 197 | ||
| Treatment | 197 | ||
| Interventional sialendoscopy | 198 | ||
| Non-inflammatory conditions | 198 | ||
| Sialadenosis/sialosis | 198 | ||
| Salivary gland cysts | 198 | ||
| Post-radiotherapy xerostomia | 198 | ||
| Neoplastic disease | 198 | ||
| Benign epithelial neoplasms | 199 | ||
| Pleomorphic adenoma | 199 | ||
| Warthin's tumour | 200 | ||
| Other benign epithelial neoplasms | 200 | ||
| Management of benign epithelial neoplasms | 200 | ||
| Recurrent benign epithelial neoplasms | 201 | ||
| Benign non-epithelial neoplasms | 201 | ||
| Malignant epithelial neoplasms | 201 | ||
| Mucoepidermoid carcinoma | 201 | ||
| Adenoid cystic carcinoma | 201 | ||
| Acinic cell carcinoma | 202 | ||
| Polymorphous low-grade adenocarcinoma | 202 | ||
| Carcinoma ex-pleomorphic adenoma | 202 | ||
| Management of epithelial malignancies | 202 | ||
| Malignant non-epithelial neoplasm | 202 | ||
| Metastatic disease to the major salivary glands | 202 | ||
| Surgical principles | 203 | ||
| Parotid surgery | 203 | ||
| Partial parotidectomy | 203 | ||
| Deep lobe parotidectomy/total parotidectomy with facial nerve preservation | 205 | ||
| Radical parotidectomy | 205 | ||
| Extended radical parotidectomy | 205 | ||
| Parapharyngeal space tumours | 205 | ||
| Submandibular gland surgery | 205 | ||
| Minor salivary gland surgery | 206 | ||
| Surgical complications | 206 | ||
| Intraoperative complications | 206 | ||
| Facial nerve palsy | 206 | ||
| Frey's syndrome | 206 | ||
| Other postoperative complications | 207 | ||
| References | 207 | ||
| Index | 211 |